Analysis of a series of 85 temporalis muscle flaps performed in 81 patients is presented. The flaps were used in a wide range of locations ranging from intracranial to mandible and for a large variety of diagnostic categories. A detailed examination of the indications and use of the muscle for cranial base and palatal defects is provided. The amount of muscle used varied considerably from 10 to 90 percent. Complications associated with the use of the temporal muscle included a 2.4 percent total flap failure rate and a 9.4 percent minor complication rate. When greater than half the muscle was used, temporal hollowing, the principal donor defect, was imperceptible (39 percent) or mild (46 percent) in a majority of patients and severe in only a few (16 percent). Recommendations for prevention and treatment of this contour deformity are discussed in depth.